Healthcare Provider Details

I. General information

NPI: 1356265292
Provider Name (Legal Business Name): MIND AND WELLNESS INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 E 49TH ST STE 102
HIALEAH FL
33013-1907
US

IV. Provider business mailing address

755 E 49TH ST STE 102
HIALEAH FL
33013-1907
US

V. Phone/Fax

Practice location:
  • Phone: 305-505-3948
  • Fax:
Mailing address:
  • Phone: 305-505-3948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BRANDON TADEO DE FUSCO
Title or Position: MGR
Credential:
Phone: 305-505-3948